母婴保健中护患关系的作用：坦桑尼亚农村地区的一项定性研究

The role of nurse-client relationships in maternal and child healthcare: a qualitative study in rural Tanzania.

作者信息

Isangula Kahabi, Mwasha Loveluck, Pallangyo Eunice, Ndirangu-Mugo Eunice

机构信息

School of Nursing and Midwifery, The Aga Khan University, Dar Es Salaam, Tanzania.

School of Nursing and Midwifery, The Aga Khan University, Nairobi, Kenya.

出版信息

Front Health Serv. 2023 Jun 26;3:1058840. doi: 10.3389/frhs.2023.1058840. eCollection 2023.

DOI:10.3389/frhs.2023.1058840

PMID:37435510

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10331615/

Abstract

BACKGROUND

The literature suggests that poor provider-client relationships in maternal and child healthcare (MCH) continue to impact healthcare service uptake, continuity of care, and MCH outcomes. However, there is a paucity of literature on the benefits of the nurse-client relationship for clients, nurses, and the health system, particularly in rural African contexts.

OBJECTIVE

This study examined the perceived benefits and disadvantages of good and poor nurse-client relationships in rural Tanzania respectively. We present the findings of a community-driven inquiry that was the first step of a broader study that sought to co-design an intervention package for strengthening nurse-client relationships in MCH in rural contexts using a human-centred design approach.

METHODS

This study used a qualitative descriptive design. Nine focus group discussions and 12 key informant interviews were conducted using semi-structured interview guides. Participants were purposefully selected nurses/midwives and clients attending MCH services, and MCH administrators. Data were managed using NVivo and analysed thematically.

RESULTS

A range of perceived benefits of good nurse-client relationships and disadvantages of poor relationships emerged. Perceived benefits of good nurse-client relationships included: (i) benefits to clients (increased healthcare-seeking behaviours, disclosure, adherence, return to care, positive health outcomes, and referral tendencies); (ii) benefits to nurses (increased confidence, efficiency, productivity, job satisfaction, trust, and community reputation and support); and (iii) benefits to healthcare facilities/systems (increased client load and consequently income, fewer complaints and legal disputes, increased trust and facility delivery, and reduced maternal and child deaths). The disadvantages of poor nurse-client relationships were basically the opposite of their benefits.

CONCLUSION

The benefits of good nurse-client relationships and the disadvantages of poor relationships extend beyond patients and nurses to the healthcare system/facility level. Therefore, identifying and implementing feasible and acceptable interventions for nurses and clients could pave the way for good nurse-client relationships, leading to improved MCH outcomes and performance indicators.

摘要

背景

文献表明，母婴保健（MCH）中医护人员与服务对象关系不佳，持续影响着医疗服务的利用、连续护理以及母婴保健结果。然而，关于护患关系对服务对象、护士及卫生系统的益处，尤其是在非洲农村地区，相关文献匮乏。

目的

本研究分别考察了坦桑尼亚农村地区良好和不良护患关系的感知益处与弊端。我们展示了一项社区主导调查的结果，该调查是一项更广泛研究的第一步，该研究旨在采用以人为本的设计方法，共同设计一套干预方案，以加强农村地区母婴保健中的护患关系。

方法

本研究采用定性描述性设计。使用半结构化访谈指南进行了9次焦点小组讨论和12次关键 informant 访谈。参与者特意选取了提供母婴保健服务的护士/助产士、服务对象以及母婴保健管理人员。数据使用NVivo进行管理，并进行主题分析。

结果

出现了一系列关于良好护患关系的感知益处和不良关系的弊端。良好护患关系的感知益处包括：（i）对服务对象的益处（增加就医行为、信息披露、依从性、复诊、积极的健康结果以及转诊倾向）；（ii）对护士的益处（增强信心、提高效率、提升生产力、增加工作满意度、增强信任以及提升社区声誉和支持）；以及（iii）对医疗机构/系统的益处（增加服务对象数量从而增加收入、减少投诉和法律纠纷、增强信任和机构分娩率、降低孕产妇和儿童死亡率）。不良护患关系的弊端基本上与益处相反。